HealthSheets™

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Understanding Selective Mutism

Selective mutism is when a child can’t speak in certain settings, but can speak fine in others. For example, a child may not be able to speak at school, but can speak with no problem at home. It is called selective mutism because the child is only mute in certain situations. It’s a rare childhood condition. It can cause problems with school and social situations. Selective mutism often begins in very young children, around ages 2 to 4. But it may not be noticed until a child starts school.

Social anxiety

A child with selective mutism may find certain social situations very stressful. This may cause anxiety so severe that the child feels unable to speak. Selective mutism is not caused by a child’s willful refusal to speak. In some cases a child may also have other speech problems. But in many cases a child may not have any trouble at all speaking when he or she feels comfortable.

What causes selective mutism?

There is no single known cause of selective mutism. Researchers are still learning about things that can lead to selective mutism. They include:

An anxiety disorder

Poor family relationships

Untreated psychological issues

Self-esteem problems

Problems with sound processing

Family history of anxiety disorders

A traumatic experience

Selective mutism can also run in families.

Signs of selective mutism

The main sign of selective mutism is a month or more of failure to speak only in certain social situations. The problem is not because of another communication disorder, such as autism. And it is not because the child does not know the spoken language.

Some children with selective mutism may show additional signs, such as:

Anxiety

Social withdrawal

Excessive shyness

Obsessive compulsive disorder

Depression

Developmental delay

Communication disorders

Elimination (urine or stool) disorders

Diagnosing selective mutism

Your child’s healthcare provider will ask you about your child’s health history and signs and symptoms. You’ll be asked about your child’s speech and language development. It may help to bring your child’s school reports and teacher comments to the appointment. Your child’s healthcare provider might want to observe your child at home and at school. You may be asked to record videos of your child at home or school.

Your child will be given a physical exam. This will include an exam of your child’s ears, lips, tongue, and jaws. Your child may also have a neurological exam. He or she may also need a hearing test. The healthcare provider will look to rule out other medical conditions, such as schizophrenia.

Other healthcare providers may help assess your child. These may include:

Speech-language pathologist (SLP). He or she can assess your child’s ability to understand and use language.

Psychologist or psychiatrist. He or she can help find emotional issues that may cause the condition.